摘要
目的分析神经探测技术(IONM)在腔镜甲状腺手术中对喉返神经的保护作用。方法选取2017年7月至2020年7月甘肃省人民医院通过胸乳入路进行内镜下甲状腺大部分或全部切除的71例甲状腺肿瘤患者的临床资料,随机分为对照组(n=36)和神经探测组(n=35)。对照组采用常规性腔镜甲状腺手术,神经探测组在术中当靠近甲状腺背侧,即喉返神经所走行区域时,先用神经探测仪分别确定双侧喉返神经的位置,加以显露,予以保护。通过统计手术平均时间、术后平均住院时间、术后引流管拔除时间,术后24 h切口平均引流量、术中平均出血量、术中肌电图的响应幅度、术后并发症等指标比较研究IONM在腔镜甲状腺手术中对喉返神经保护效果。结果神经探测组手术时间、术后住院时间、术后引流管时间和术后24 h切口平均引流量均低于对照组,差异有统计学意义(P<0.05);神经探测组术中肌电图的平均响应幅度:V1为(800±345)μV,R1为(1120±219)μV,R^(2)为(1147±315)µV,V2为(1203±247)µV。神经探测组术后并发症(喉返神经损伤、声音嘶哑,呼吸困难、吞咽困难)的发生率均明显低于对照组,差异有统计学意义(P<0.05)。结论腔镜甲状腺手术结合IONM,可协助暴露和保护喉返神经,从而减少并发症的发生率,使手术更安全可靠。
Objective To analyze the protective effect of intraoperative neuro-monitoring(IONM)on recurrent laryngeal nerve in endoscopic thyroidectomy.Methods The clinical data of 71 patients with thyroid tumor who underwent endoscopic partial or total thyroidectomy through breast-chest approach admitted to Gansu Provincial Hospital from July 2017 to July 2020 were selected.They were randomly divided into the control group(n=36)and the neuro-monitoring group(n=35).The control group was treated with conventional endoscopic thyroidectomy.In the neuro-monitoring group,when it was close to the back of thyroid gland,that was,the area where the recurrent laryngeal nerve spread,the nerve detectors were first used to determine the positions of the bilateral recurrent laryngeal nerves,which were thus exposed and protected.At the same time,the protection effect of neuro-monitoring technology on recurrent laryngeal nerve in endoscopic thyroidectomy was studied by comparing the average operation time,average postoperative hospitalization time,postoperative drainage tube removal time,average 24 h postoperative incision drainage volume,average intraoperative hemorrhage volume,intraoperative electromyogram response amplitude,postoperative complications and other indices.Results The operation time,postoperative hospitalization time,postoperative drainage tube removal time and average 24 h postoperative incision drainage volume in the neuro-monitoring group were all lower than those in the control group,with statistically significant differences(P<0.05).The average response amplitude of intraoperative electromyogram in the neuro-monitoring group was(800±345)μV in V1,(1120±219)μV in R1,(1147±315)µV in R^(2) and(1203±247)µV in V2.The incidences of postoperative complications(recurrent laryngeal nerve injury,hoarseness,dyspnea and dysphagia),in the neuro-monitoring group were all remarkably lower than those in the control group,with statistically significant differences(P<0.05).Conclusion Endoscopic thyroid surgery combined with neuro-monitoring technology can help to expose and protect recurrent laryngeal nerve,thus reducing the incidence of complications and making the operation safer and more reliable.
作者
田宏伟
王芳
赵文龙
包亚斌
侯景文
蒋文杰
Guido Schürmann
TIAN Hongwei;WANG Fang;ZHAO Wenlong;BAO Yabin;HOU Jingwen;JIANG Wenjie;Guido Schürmann(Department of General Surgery,Gansu Provincial Hospital,Gansu,Lanzhou 730000,China;Medical Experimental Center,Lanzhou University,Gansu,Lanzhou 730000,China;Department of General Surgery,Jiayuguan City Hospital of TCM,Gansu,Jiayuguan 735100,China;Department of General Surgery,Affiliated Hospital of Gansu University of Chinese Medicine,Gansu,Lanzhou 730000,China;Department of General Surgery,Bielefeld Hospital,Bielefeld 33689,Germany)
出处
《中国医药科学》
2023年第6期7-11,共5页
China Medicine And Pharmacy
基金
国家自然科学基金(81902364)
甘肃省自然科学基金项目(20JR10RA403)
中央引导地方科技发展资金项目(YDZX20216200004349)
中国高等教育学会2022年度高等教育科学研究规划课题(22SY0221)。
关键词
腔镜甲状腺手术
甲状腺切除术
手术后并发症
喉返神经
神经探测技术
Endoscopic thyroidectomy
Thyroidectomy
Postoperative complications
Recurrent laryngeal nerve
Neuro-monitoring technology
作者简介
通讯作者:王芳。
